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Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open-label randomised substudy of the ANRS IPERGAY trial

2017; Elsevier BV; Volume: 18; Issue: 3 Linguagem: Inglês

10.1016/s1473-3099(17)30725-9

1474-4457

Jean‐Michel Molina, Isabelle Charreau, Christian Chidiac, Gilles Pialoux, Éric Cua, Constance Delaugerre, Catherine Capitant, Daniela Rojas Castro, Julien Fonsart, Béatrice Berçot, Cécile Bébéar, Laurent Cotte, Olivier Robineau, François Raffi, Pierre Charbonneau, Alexandre Aslan, Julie Chas, Laurence Niedbalski, Bruno Spire, Luis Sagaon‐Teyssier, Diane Carette, Soizic Le Mestre, Véronique Doré, Laurence Meyer, Claire Pintado, Bénédicte Loze, Caroline Gatey, Diane Ponscarme, Pauline Penot, R. Verón, Jean-Paul Delgado, Ernest Dallé, S Parlier, Isabelle Madelaine, Marie Danet, Nadia Mahjoub, N Mezreb, Khafil Moudachirou, Stéphane Morel, G Conort, F Lorho, M Meunier, Willy Rozenbaum, Christine Monfort, J Foucoin, B Boissavy, S Cousseau, S Huon, Marie Danet, A Djessima, V Berrebi, Anne Adda, S. Le Nagat, L. Zarka, J Berdougo, N. Mzoughi, Florian Clément, A Decouty, C Chapolard, Matthieu Godinot, C. Adouard-groslafeige, J. Koffi, Aymeric Pansu, Ann De Becker, Sophie Pailhes, Fabrice Bonnet, François Jeanblanc, Céline Brochier‐Armanet, X Teruin, Soumaya El Rouby, L Gilly, C Etienne, F Tolonin, S Bréaud, V Péchenot, S Bagge, T Cepitelli, P. Roger, Éric Rosenthal, Antoine Chéret, Pauline Cornavin, Sarah Vandamme, J Lambec, N Dumon, O Leclanche, T. Huleux, Raphaël Biekre, H. Melliez, H. Bazus, A. Pasquet, C. Bernaud, M. Besnier, B. Bonnet, Nolwenn Hall, M Cavellec, H Hüe, L Larmet, M. Colas, Rémy Choquet, S. Fouéré, Emmanuelle Netzer, Nicolas Leturque, J Binesse, Valérie Foubert, Marine Saouzanet, F. Euphrasie, B Guillon, Y Saïdi, Marie Suzan, G Cattin, Baptiste Demoulin, Nicolas Lorente,

HIV, Drug Use, Sexual Risk

BackgroundIncreased rates of sexually transmitted infections (STIs) have been reported among men who have sex with men. We aimed to assess whether post-exposure prophylaxis (PEP) with doxycycline could reduce the incidence of STIs.MethodsAll participants attending their scheduled visit in the open-label extension of the ANRS IPERGAY trial in France (men aged 18 years or older having condomless sex with men and using pre-exposure prophylaxis for HIV with tenofovir disoproxil fumarate plus emtricitabine) were eligible for inclusion in this open-label randomised study. Participants were randomly assigned (1:1) at a central site to take a single oral dose of 200 mg doxycycline PEP within 24 h after sex or no prophylaxis. The primary endpoint was the occurrence of a first STI (gonorrhoea, chlamydia, or syphilis) during the 10-month follow-up. The cumulative probability of occurrence of the primary endpoint was estimated in each group with the Kaplan-Meier method and compared with the log-rank test. The primary efficacy analysis was done on the intention-to-treat population, comprising all randomised participants. All participants received risk-reduction counselling and condoms, and were tested regularly for HIV. This trial is registered with ClinicalTrials.gov number, NCT01473472.FindingsBetween July 20, 2015, and Jan 21, 2016, we randomly assigned 232 participants (n=116 in the doxycycline PEP group and n=116 in the no-PEP group) who were followed up for a median of 8·7 months (IQR 7·8–9·7). Participants in the PEP group used a median of 680 mg doxycycline per month (IQR 280–1450). 73 participants presented with a new STI during follow-up, 28 in the PEP group (9-month probability 22%, 95% CI 15–32) and 45 in the no-PEP group (42%, 33–53; log-rank test p=0·007). The occurrence of a first STI in participants taking PEP was lower than in those not taking PEP (hazard ratio [HR] 0·53; 95% CI 0·33–0·85; p=0·008). Similar results were observed for the occurrence of a first episode of chlamydia (HR 0·30; 95% CI 0·13–0·70; p=0·006) and of syphilis (0·27; 0·07–0·98; p=0·047); for a first episode of gonorrhoea the results did not differ significantly (HR 0·83; 0·47–1·47; p=0·52). No HIV seroconversion was observed, and 72 (71%) of all 102 STIs were asymptomatic. Rates of serious adverse events were similar in the two study groups. Gastrointestinal adverse events were reported in 62 (53%) participants in the PEP group and 47 (41%) in the no-PEP group (p=0·05).InterpretationDoxycycline PEP reduced the occurrence of a first episode of bacterial STI in high-risk men who have sex with men.FundingFrance Recherche Nord & Sud Sida-HIV Hépatites (ANRS) and Bill & Melinda Gates Foundation.